| NPI | 1760577167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC003162) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA PC003162) |
| 101YP2500X Counselor Professional (Licence: PA PC003162) | |
| 106H00000X Marriage & Family Therapist (Licence: PA PC003162) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |